Cardillo Giuseppe, Lucchi Marco, Marulli Giuseppe, Infante Maurizio, Leuzzi Giovanni, Mussi Alfredo, Carleo Francesco, Facciolo Francesco, Voulaz Emanuele, Rea Federico, Rapicetta Cristian, Lococo Filippo
Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy.
Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy.
Lung Cancer. 2016 Mar;93:88-94. doi: 10.1016/j.lungcan.2016.01.008. Epub 2016 Jan 19.
So far no specific oncological strategies have been validated for locally-advanced epithelial thymic tumors (TETs). We herein report the long-term results of a large multicentric experience adopting a multimodal treatment.
From 01/1990 to 12/2010, the clinical data of 108 Masaoka Stage-III TETs patients surgically treated after induction therapy (IT) were retrospectively reviewed. Different IT-regimens were administered: ADOC (32 pts); PAC (38 pts); CEE (38 pts). Radiotherapy was concurrently used in 5 patients only. The end-points of the study were the evaluation of: (1) resectability; (2) overall long-term survival (LTS) and disease-free survival (DFS); and (3) independent prognostic factors. The Mann-Whitney and Fisher's exact tests were applied to test the associations. Survival analysis was performed by the Kaplan-Meier method and log-rank test.
Mean age and male/female ratio were 51 ± 13 years and 61/47, respectively. World Health Organization (WHO) histotype was: A in 6 pts (5.6%), AB in 18 (16.7%), B1 in 15 (13.9%), B2 in 26 (24.1%), B3 in 23 (21.3%), and thymic carcinoma in 20 (18.5%). Thirty-day mortality was 1.8%. A total of 81 (75%) had R0-resection, 11 (10.2%) R1 and 16 (14.8%) R2-resection. Adjuvant therapy was performed in 71 patients. During the follow-up a relapse of disease was observed in 38 pts(35.2%). Five-years DFS and LTS were 69.3% and 79.3%, respectively. At univariate analysis, WHO-type B3/C ("high-risk") TETs (p=0.001) and recurrence of disease (p=0.02) were predictors of poor LTS while only a slight correlation was found for R-status and "CHT-regimen type" (p=0.097 and p=0.067, respectively). At multivariate analysis WHO "high-risk" TETs (H.R.5.73;C.I.:1.77-18.57) and ADOC-regimen (H.R.2.84;C.I.:1.37-5.86) were independent predictors of poor survival.
A multimodal treatment for Stage-III thymic tumors may achieve a rewarding survival. WHO-Histology seems to be the most important prognostic factor.
迄今为止，尚未有针对局部晚期上皮性胸腺肿瘤（TETs）的特定肿瘤学策略得到验证。我们在此报告一项采用多模式治疗的大型多中心研究的长期结果。
回顾性分析1990年1月至2010年12月期间108例接受诱导治疗（IT）后接受手术治疗的Masaoka III期TETs患者的临床资料。采用了不同的IT方案：ADOC（32例）；PAC（38例）；CEE（38例）。仅5例患者同时接受了放疗。研究的终点包括：（1）可切除性；（2）总体长期生存（LTS）和无病生存（DFS）；（3）独立预后因素。应用Mann-Whitney检验和Fisher精确检验来检验相关性。采用Kaplan-Meier方法和对数秩检验进行生存分析。
平均年龄和男女比例分别为51±13岁和61/47。世界卫生组织（WHO）组织学类型为：A期6例（5.6%），AB期18例（16.7%），B1期15例（13.9%），B2期26例（24.1%），B3期23例（21.3%），胸腺癌20例（18.5%）。30天死亡率为1.8%。共有81例（75%）实现R0切除，11例（10.2%）R1切除，16例（14.8%）R2切除。71例患者接受了辅助治疗。随访期间，38例（35.2%）患者出现疾病复发。5年DFS和LTS分别为69.3%和79.3%。单因素分析显示，WHO B3/C型（“高危”）TETs（p=0.001）和疾病复发（p=0.02）是LTS不良的预测因素，而R状态和“CHT方案类型”仅存在轻微相关性（分别为p=0.097和p=0.067）。多因素分析显示，WHO“高危”TETs（风险比5.73；置信区间：1.77 - 18.57）和ADOC方案（风险比2.84；置信区间：1.37 - 5.86）是生存不良的独立预测因素。
III期胸腺肿瘤的多模式治疗可能取得良好的生存效果。WHO组织学类型似乎是最重要的预后因素。
